An Audit on pediatric surgery services at Sinnar Teaching Hospital: outcome and challenges

ABSTRACT

a valuable data for health authorities. The aim of this study was to reflect the burden and outcome of one pediatric surgery unit at Sinnar Teaching Hospital (STH). It also throws some light into challenges and obstacles that face running of pediatric surgery services outside of the capital. Methods: This was a retrospective, descriptive review. It included all the patients who presented to the Pediatric Surgery Unit at Sinnar Teaching Hospital (STH) and underwent emergency or elective operations during the period from January 2009 to December 2012. Results: A total number of 2400 patients were seen at the unit over four years. About half of them (1210) (50.4%) underwent emergency or elective operations. Inguinoscrotal conditions were the most frequently performed elective operations 450 (37%). Appendectomy was the commonest emergency operation 169 (14%). Forty four (2%) were referred to Al-Jazeera or Khartoum States for further work-up or advanced care. The majority of the referred cases were those who required more specialized oncological or neurosurgical services, in addition to some patients who needed non-invasive interventions (like ESWL for instance) or multidisciplinary management(bladder exostrophy and proximal hypospadias). The overall mortality rate was 2.4% (n=52) with higher mortality rate noticed among neonatal conditions 20% of it (n=10) due to lack of trained anesthetists, pediatric intensive care unit facilities, and delayed presentation.Conclusion: Conduction of a pediatric surgery service outside of the capital is challenging and faces various obstacles, but it is possible with a reasonable outcome. A wide variety of emergency and elective pediatric surgical conditions are seen and the majority of them could be managed properly at a state hospital level. Availability of well-established anesthetic and pediatric intensive care facilities, with trained nursing staff is the cornerstone for better quality services with minimum morbidity and mortality rates. Establishment of pediatric surgery services in the states would invariably decrease the central congestion and referral to capital hospitals. It can also minimize the unnecessary, and indeed, costly expenditure on referral,especially for low-and middle- income families